Evidence map›Paper›PMID 41314826›Full record

ArticleBMJ open2025

Comparison of intention-to-treat and per-protocol results in non-inferiority trials: a methodological review protocol.

Sameer Parpia, Sandra Ofori, Tyler McKechnie, Naveen Rajan, Yang Wang, Borong Wang, Gordon Guyatt

Abstract read
In one paragraph

Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Sameer ParpiaDepartment of Oncology, McMaster University, Hamilton, Ontario, Canada parpia@mcmaster.ca.ORCID http://orcid.org/0000-0002-9407-5622
Sandra OforiDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
Tyler McKechnieDepartment of Surgery, McMaster University, Hamilton, Ontario, Canada.ORCID http://orcid.org/0000-0002-7668-4096
Naveen RajanDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
Yang WangDepartment of Oncology, McMaster University, Hamilton, Ontario, Canada.ORCID http://orcid.org/0009-0001-3138-0689
Borong WangDepartment of Surgery, McMaster University, Hamilton, Ontario, Canada.
Gordon GuyattDepartment of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionNon-inferiority (NI) trial designs, which assess whether an experimental intervention is no worse than the standard of care, have become increasingly prevalent in recent years. Current thinking suggests that the intention-to-treat (ITT) analysis is considered anti-conservative in the presence of protocol violations when compared with the per-protocol (PP) analysis. METHODS AND ANALYSIS: We aim to conduct a methodological review of NI trials to compare the results from ITT and PP analysis in NI trials. A comprehensive electronic search strategy will be used to identify studies indexed in MEDLINE, Embase and Cochrane Central Register of Controlled Trials databases. We will include 390 NI trials published prior to 31 December 2024. The primary outcomes are the treatment effect estimates from ITT and PP analyses. Secondary outcomes are the CI widths and the bounds of the CIs from the ITT and PP analyses. Analysis will calculate the relative difference in the point estimates, CI widths and CI bounds between the two approaches. Linear models will be used to investigate the relationship between the outcomes and the proportion of patients excluded from the PP analysis. ETHICS AND DISSEMINATION: This is a methodological review that has been registered on the International Prospective Register for Systematic Reviews (PROSPERO, CRD420251125360). Research ethics is not required as the project is a methodological review of previously published trials. Study findings will be shared via peer-reviewed publications and presentations at academic conferences.

Indexed as

Equivalence Trials as TopicIntention to Treat AnalysisResearch DesignHumansReview Literature as TopicClinical TrialMethodsSTATISTICS & RESEARCH METHODS

Identifiers

PMID41314826
PMCPMC12666176

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.